Pediatricians and Gun Violence among Children and Adolescents

The surge in mass killings during the last five years has coincided with the lapse of the legislative ban on assault weapons. The year 2012 was particularly notorious, with 5 such major events in the headlines. A few states, such as California and Massachusetts, have enacted some legislation to ban these weapons. The reintroduction of a nationwide ban is endorsed by the AAP and many senior law enforcement officials.

In light of this, at the 2014 AAP National Conference & Exhibition, Robert D. Sege, MD, PhD, FAAP, Professor of Pediatrics, Boston University School of Medicine, Boston, MA, presented information based on the American Academy of Pediatrics (AAP) Policy Statement: Firearm-Related Injuries Affecting the Pediatric Population, 2012.

According to Sege, every week one person under 15 years dies and every day at least one child receives a non-fatal injury. Fatal shootings are usually inflicted by other children - typically friends or siblings.

Children are curious and gun-safety lectures aimed at kids don’t work, in Sege’s experience. An exception may be specific, hands-on training such as parents or professional instructors teaching children the practical, age-appropriate use of hunting rifles. Reduced child access to guns is what prevents accidents, in this speaker’s opinion.

Teen suicide (ages 15-19 years) is an area of major concern due to the impulsiveness of this age group. It is the third leading cause of death due to firearms (3.4 per 100,000) with a 90% mortality rate. There is an association between stricter gun laws and a lower incidence of gun-related fatalities, especially suicide. Even slowing down the permitting process can allow time for the potential suicide candidate to reconsider.

Homicide statistics for the age range 15-19 years reveal that 84.5% were firearms-related, with male deaths vastly outnumbering those of females. Young black males have the highest rates, especially in the inner cities.

Community activities, such as midnight basketball and arts programs, have showed promise in reducing these statistics. However, the “broken windows” model, restoring order by aggressive policing, for example in New York, has proven controversial due to the tendency to focus on minority areas.

Sege presented data from the Centers of Disease Control and Boston University Web-based Injury Statistics Query and Reporting System (WISQARS) database which showed a consistently rising correlation between Household Gun Ownership (%) and the Age-Adjusted Firearm Homicide Rate for 50 States between the years 1981 and 2010. Risk of homicide is greater with drug, alcohol and tobacco use. One study, surprisingly, found that tobacco was the biggest factor.

Some states have attempted to enact legislation preventing pediatricians and other physicians from counseling parents and children on gun safety in the home. Only Florida, to date, has actually brought such a law on to the statute. The 2012 AAP Policy Statement includes a provision for counseling parents about firearms. Pediatricians should play to their strengths; ie their knowledge of children and their families. They are in a weaker position regarding the technicalities of the use of firearms and related legal and constitutional issues.

Families should be counseled to firearms away from children, particularly teenagers. Parents should keep guns locked up or, at least fit gun locks, and lock ammunition away separately. However, such measures are more effective for younger children. Determined teenagers are more resourceful. Where there is a disturbed adolescent who shows signs of being suicidal, arrangements should be made to remove weapons from the house altogether until the danger has passed.

The AAP has a program called Connected Kids to keep children “safe, strong and secure” which offers a comprehensive approach to youth violence prevention.

To recap, there are three general types of gunshot-related deaths among young people: accidents occurring mainly with young children, suicide in adolescents and homicide among older teens and young adults.

Pediatricians and other physicians should learn how to counsel parents about keeping their children safe from firearms injuries and be able to advocate for effective state and local authority firearms regulation.